Report Cards & Reputational Incentives

1. Report Cards & Reputational Incentives Moreover, Hospitals have RIs to obtain a (+) report cards “ Ranked among the top 10 hospitals in New York State for cardiac surgery and cardiac catheterization programs” (CMS discourages hospital from using its data for advertisement; and avoids ranking hospitals) http://images.google.com/imgres?imgurl=http://www.worldclassmedicine.com/images/heart/main_image.jpg&imgrefurl=http://www.worldclassmedicine.com/homepage_heart.cfm%3Fid%3D21&usg=__aaZsK6rltIX6fx3iMcQ29-GaU8Y=&h=249&w=286&sz=15&hl=en&start=8&tbnid=y1zmptwLLVTdpM:&tbnh=100&tbnw=115&prev=/images%3Fq%3Dtop%2Bcardiac%2Bsurgeon%2Bnew%2Byork%2Brated%26gbv%3D2%26hl%3Den%26safe%3Dactive (accessed 11/25/08).

2. Report Cards & Reputational Incentives • Disruptive Innovation & Physicians • Market impact of a (-) report card is more clear cut http://www.hikingupward.com/OVH/SkyMeadows/images/122907/PC290099.jpg

3. Report Cards & Reputational Incentives • NYS cardiac surgery registry • 5% of surgeons with the lowest operative mortality exited the market • 20% of surgeons with the highest operative mortality exited the market • 2/3 of surgeons admitted to “cherry picking” patients Ashish K. Jha and Arnold M. Epstein. The predictive accuracy of the New York State coronary artery bypass surgery report-card system. 25 Health Aff 844, 844–55 (2006);

4. Report Cards & Reputational Incentives • Objective evidence of cherry picking: Statistically significant reduction in the number of redo-CABGs being performed TR McLean, In New York State, do more percutaneous coronary interventions mean fewer or more complex referrals to cardiac surgeons? 6(1) Am Heart Hospital J 30, 30-36 (2008).

5. Report Cards & Reputational Incentives Just like hospitals, Physicians make use of (+) report cards “Dr. Ty Goletz is a top-rated orthopedic surgeon who has received numerous awards and accolades throughout the United States, including being chosen as one of San Antonio’s Top Doctors, and a Texas Super Doctor by Texas Monthly Magazine.” http://images.google.com/imgres?imgurl=http://www.drgoletz.com/images/goletz.jpg&imgrefurl=http://www.drgoletz.com/about_goletz.html&usg=__Yggms_l5A8A2rDRBtqgrSiUKZZw=&h=285&w=244&sz=17&hl=en&start=3&tbnid=HyvJGfl4k_29tM:&tbnh=115&tbnw=98&prev=/images%3Fq%3D%2522surgeon%2522%2B%2522top%2Brated%2522%26gbv%3D2%26hl%3Den%26safe%3Dactive (accessed 11/15/08)

6. Report Cards & Reputational Incentives All I ever needed to know about report cards, I learned in 3rd grade: They change behavior The Key question is how is the government going to use (capitalize) on this information? McLean TR: Will reputational incentives stimulate a reversal of the physician brain drain?. J Health Serv Res Policy 2008; 13:50-52; Werner RM and Asch DA: The Unintended Consequences of Publicly Reporting Quality Information. JAMA 2005; 293:1239-1244

7. Report Cards & Reputational Incentives • Answer: • Two new CMS initiatives: • Hospital Quality Initiative (HQI) • Physician Quality Reporting Initiative (PQRI) Image URL on request

8. Report Cards & Reputational Incentives • Common to both HQI & PQRI are paradigm shifts: • Accountability shifts from structure (e.g. JC accreditation) to outcomes (e.g. SSI) • Benchmarking for provider comparison Brett Elliott: Pay for Performance and the Hospital Quality Initiative. Del Med Jrl 2005, 77(8):288-96.

9. Report Cards & Reputational Incentives • HQI • MMA § 501b; Pub L 108-173 (117 Stat. 2066) • But, CMS lacks statutory authority to collect provider specific data. • “Voluntary” performance measurement reporting began 2004 Brett Elliott: Pay for Performance and the Hospital Quality Initiative. Del Med Jrl 2005, 77(8):288-96.